Differences in biopsychosocial profiles of diabetes patients by level of glycaemic control and health-related quality of life: The Maastricht Study

Elissen, Arianne; Hertroijs, Dorijn F. L.; Schaper, Nicolaas C.; Bosma, Hans; Dagnelie, Pieter C.; Henry, Ronald M.A.; Kallen, Carla; Koster, Annemarie; Schram, Miranda T.; Stehouwer, Coen D. A.; Schouten, Jan S.A.G.; Berendschot, Tos T. J. M.; Ruwaard, Dirk

doi:10.1371/journal.pone.0182053

Cited by 16 publications

(19 citation statements)

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“…Socio-economic factors like employment status, income, and educational status showed significant associations with HRQoL on bivariate analysis, but not on multivariable analysis. Similar associations have been reported previously in patients with diabetes [ 37 , 38 ] and underline the need for tailored clinico-social interventions in specific subgroups to improve health outcomes. However, since most studies have been cross-sectional in nature, it is also unclear whether employment and income levels are the cause or effect of DPN and HRQoL status.…”

Section: Discussionsupporting

confidence: 87%

Functional status mediates the association between peripheral neuropathy and health-related quality of life in individuals with diabetes

et al. 2017

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AimsTo examine differences in health-related quality of life (HRQoL) between patients with and without diabetic peripheral neuropathy (DPN), and whether these differences can be explained by functional deficits.MethodsThis was a cross-sectional study of 160 patients with type 2 diabetes mellitus, 80 with DPN and 80 without. Assessments included HRQoL (health utility score derived from EQ-5D-5L), functional status measurements [muscle strength, timed up and go (TUG), five times sit-to-stand (FTSTS), functional reach, body sway velocity] and self-reported balance confidence [Activities-specific Balance Confidence (ABC) scale].ResultsMean utility scores were 0.67 ± 0.14 and 0.77 ± 0.16 in patients with and without DPN, respectively (p < 0.001). Patients with DPN had lower great toe extensor strength (6.4 ± 1.8 vs 7.6 ± 2.8 lbs, p = 0.001), greater body sway velocity (2.40 ± 1.31 vs 1.90 ± 0.52 mm/s, p = 0.002), slower TUG (12.1 ± 4.6 vs 10.1 ± 2.3 s, p < 0.001) and FTSTS (15.8 ± 5.8 vs 13.9 ± 5.4 s, p = 0.03) scores, and lower ABC score (73.4 ± 21.3 vs 82.6 ± 16.9, p = 0.003), compared to those without DPN. On stepwise multiple regression, DPN status, FTSTS, body sway velocity, BMI, diabetes duration, pain, and gender explained 38% of HRQoL variance. Addition of ABC score into the model explained 45% of variance. Results from structural equation modelling showed that DPN had direct effects on HRQoL and indirect effects through FTSTS, body sway velocity, and ABC score, with χ 2 = 8.075 (p = 0.044), root mean square error of approximation = 0.103 (lower bound 0.015, upper bound 0.191), Comparative Fit Index = 0.966, Tucker–Lewis Index = 0.887, and Standardized Root Mean Square Residual = 0.053.ConclusionsPatients with DPN have worse HRQoL compared to patients without DPN, partly mediated by functional status parameters. Effective interventions targeting functional status may be beneficial in improving HRQoL in these patients. Electronic supplementary materialThe online version of this article (10.1007/s00592-017-1077-8) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 87%

Functional status mediates the association between peripheral neuropathy and health-related quality of life in individuals with diabetes

et al. 2017

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“…We found no impact of anticoagulation [55], antihypertensives (no comparable data), mood stabilisers [55], and NSAIDs [59] on HRQoL. For the routine laboratory findings, we found that HbA1c (%) negatively impacted MH, aligning with the glycaemic control literature [60,61], but that the levels of proteinuria and anti-dsDNA antibodies were not related to HRQoL [7,26,62,63]. An increasing C3 level led to higher SF; however, the levels or hypocomplementemia of C3 or C4 did not influence any other HRQoL item.…”

Section: Discussionsupporting

confidence: 60%

The Impact of Cytokines on the Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus

Raymond

Eilertsen

Shanmugakumar

et al. 2019

JCM

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Introduction: Systemic lupus erythematosus (SLE) reduces the health-related quality of life (HRQoL), even during periods of disease quiescence. We investigated whether subclinical inflammation as reflected by cytokine levels is linked with reduced HRQoL. Methods: A cross-sectional study of SLE patients (n = 52, mean age 47.3, 86.5% female) who completed a Short Form Health Survey-36 (SF-36) questionnaire. The clinical and demographic data, scores for the disease activity (SLEDAI-2K), organ damage (SDI), and laboratory data were collected simultaneously. The autoantibody and cytokine levels (IFN-γ, IL-1β, IL-4, IL-6, IL-10, IL-12, IL-17, BAFF, TNF-α, TGF-β1, MIP-1α, MIP-1β and MCP-1 (levels in pg/mL) were quantified by sandwich ELISA. The comparisons and associations were assessed non-parametrically, and a multiple regression determined the effect sizes (ES) of the variables on the SF-36 domain and summary scores. Results: The SF-36 summary and domain scores for SLE patients were significantly (20–40%) lower than in a comparable control group, with the exception of the Mental Health scores (p = 0.06). SLE patients had a normal body mass index (BMI) (median, 24.2 kg/m2), a high rate of smoking (69.2%), and usage of social security benefits (90.4%). TGF-β1 (ES 0.06), IL-12 (ES −0.11), IFN-γ (ES 0.07) and MCP-1 (ES 0.06) influenced the SF-36 domain scores; and MCP-1 (ES 0.04) influenced the Mental Health Summary Score (MCS). Obvious manifestations, including patient visual analogue scale (VAS) (ES −2.84 to −6.29), alopecia (ES −14.89), malar rash (ES −14.26), and analgesic requirement (ES −19.38), independently influenced the SF-36 items; however, the SF-36 scores were not reflected by the physician VAS or disease activity (SLEDAI-2K). Conclusions: Cytokines had a minimal impact on HRQoL in SLE patients, especially compared to visible skin manifestations, central nervous system (CNS) damage, and pain. Better tools are needed to capture HRQoL in measures of disease activity.

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“…Our work corroborates the influence of socioeconomic position on intermediate health outcomes in patients with diabetes, even in a region with one of the lowest health inequality levels of Spain [ 25 ], a country that, in turn, has relatively low health inequality compared to other European countries [ 23 ]. Apart from SES-related individual characteristics that could favour results in patients with higher SES, such as healthy diet [ 44 , 45 ], physical activity [ 46 ], medication adherence [ 47 ], social support [ 44 , 46 ] or self-efficacy [ 48 ], there are also contextual factors, such as the way health care institutions are organized and the health policies they adopt, that could differentially affect patients according to their SES level [ 21 ]. This differential influence may occur even in health care systems that provide universal coverage, such as the Spanish health system, where some organizational barriers, such as copayments, may pose greater obstacles for people of lower SES [ 21 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic inequalities in cardiometabolic control in patients with type 2 diabetes

et al. 2018

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BackgroundThe aim of this study was to determine if the achievement of control targets in patients with type 2 diabetes was associated with personal socioeconomic factors and if these associations were sex-dependent.MethodsThis cross-sectional, population-based study was conducted in Spain. Glycated haemoglobin (HbA1c) level and other clinical parameters were obtained from electronic primary care records (n = 32,638 cases). Socioeconomic status was determined using education level and yearly income. Among patients, having their HbA1c level checked during the previous year was considered as an indirect measure of the process of care, whereas tobacco use and clinical parameters such as HbA1c, low-density lipoprotein cholesterol (LDL-c) and blood pressure (BP) were considered intermediate control outcomes. General linear mixed effect models were used to assess associations.ResultsThe achievement of metabolic and cardiovascular control targets in patients with type 2 diabetes was associated with educational level and income, and socioeconomic gradients differed by sex. The probability of having had an HbA1c test performed in the previous year was higher in patients with lower education levels. Patients in the lowest income and education level categories were less likely to have reached the recommended HbA1c level. Males in the lowest education level categories were less likely to be non-smokers or to have achieved the blood pressure targets. In contrast, patients within the low income categories had a higher probability of reaching the recommended LDL-c level.ConclusionsOur results suggest the presence of socioeconomic inequalities in the achievement of cardiovascular and metabolic control that differed in direction and magnitude depending on the measured outcome and sex of the patient. These findings may help health professionals focus on high-risk individuals to decrease health inequalities.

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Differences in biopsychosocial profiles of diabetes patients by level of glycaemic control and health-related quality of life: The Maastricht Study

Cited by 16 publications

References 35 publications

Functional status mediates the association between peripheral neuropathy and health-related quality of life in individuals with diabetes

Functional status mediates the association between peripheral neuropathy and health-related quality of life in individuals with diabetes

The Impact of Cytokines on the Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus

Socioeconomic inequalities in cardiometabolic control in patients with type 2 diabetes

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